. A POPULATION-BASED COHORT STUDY

Background: Shorter sleep is a risk factor for weight gain in young children. Experimental studies show that sleep deprivation is associated with higher nighttime energy intake, but no studies have examined the patterning of energy intake in relation to nighttime sleep duration in young children. Objectives: The objectives of the study were to test the hypothesis that shorter-sleeping children would show higher nighttime energy intake and to examine whether the additional calories were from drinks, snacks or meals. Methods: Participants were 1278 families from the Gemini twin cohort, using data from one child per family selected at random to avoid clustering effects. Nighttime sleep duration was measured at 16 months of age using the Brief Infant Sleep Questionnaire. Energy intake by time of day and eating episode (meal, snack, drink) were derived from 3-day diet diaries completed when children were 21 months. Results: Consistent with our hypothesis, shorter-sleeping children consumed more calories at night only (linear trend P < 0.001), with those sleeping < 10 h consuming on average 120 calories (15.2% of daily intake) more at night than those sleeping ≥ 13 h. The majority of nighttime intake was from milk drinks. Associations remained after adjusting for age, sex, birth weight, gestational age, maternal education, weight and daytime sleep. Conclusions: Shorter-sleeping, young children consume more calories, predominantly at night, and from milk drinks. Parents should be aware that providing milk drinks at night may contribute to excess intake. This provides a clear target for intervention that may help address associations between sleep and weight observed in later childhood.

Background and Aims Noninvasive ventilation (NIV) constitutes an alternative treatment for pediatric acute respiratory failure.However, tracheal intubation should not be delayed when considered necessary.Our main objective is to identify success/failure prognostic signs of NIV and determination of NIV characteristics.Methods Noncontrolled, observational study in a PICU in a university hospital.All cases of NIV from June 2010 and March 2012 were included.Failure of NIV was defined as the requirement of endotracheal intubation at any time.The major characteristics of patients who were intubated were compared with the characteristics of those who were not after a trial of NIV.Predictive factors for failure of NIV were analysed by multivariate analysis.Results 126 cases were included (60.3% males),mean age 25.3±40.5 months and mean weight 11±13 kg.There was 57.9% of type II 990 991 Objective Low birth weight infants (LBW) are at increased risk of cognitive and behavioral problems and at risk of iron deficiency (ID) which is associated with impaired neurodevelopment.We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems.Patients and methods: In a randomized controlled trial, 285 marginally LBW (2000-2500g) infants received 0, 1, or 2 mg/kg/day of iron supplements from six weeks to six months of age.At 3.5 years of age these infants and 95 normal birth weight controls were assessed with a psychometric test (WIIPSI-III) and a questionnaire of behavioral problems (CBCL).Results There were no significant differences in IQ between the LBW-groups, nor compared to controls.Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg-group respectively (p=0.924).The prevalence of children with CBCL-scores above the US subclinical cut-off was 12.7%, 2.9%, 2.7%, and 3.2% in the placebo, 1mg, 2 mg, and control-group respectively.Relative risks (95% CI) for behavioral problems vs. controls were 4.01 (1.13-14.29)Epidemiologia, Instituto Nacional de Saúde Ricardo Jorge; 5 Administração Regional de Saúde Lisboa e Vale do Tejo, Direção Geral de Saúde, Lisbon; 6 Administração Regional de Saúde Alentejo, Direção Geral de Saúde, Sines, Portugal Introduction Low birth weight (LBW) is defined by the World Health Organization as weight at birth of less than 2500 g.Epidemiological observations suggest that LBW contributes to a range of poor infant's health outcomes.Other studies suggest that an increase of outdoor air pollution levels may increase the incidence of LBW.This article presents results from a semi-ecological analysis of association between outdoor air quality and LBW in a cohort of mothers participating in Gestão Integrada Saúde e Ambiente (GISA) project, in Alentejo Litoral region (Portugal).Materials Individual data on birth weight, residence, demographic, social and clinical covariates were collected by questionnaire from mothers (n=1393) participating on GISA project.Air quality data was collected with a lichen diversity biomonitoring program measured at spatiality distributed sampling sites (n=84).Methods Lichen biomonitoring was used to derive a continuous metric of outdoor air quality exposure.Geostatistical simulation was applied to lichen diversity data to derive equally probable maps of air quality with different exposure scenarios for each pregnant, to gain insight into exposure distribution and exposure uncertainty.Generalized linear models were used to predict the odds of LBW.Results Factors found significantly (p<0.05)associated to LBW: smoking habits, prenatal surveillance, body mass index, intrauterine growth, weight gain during pregnancy, previous LBW.Air quality was not associated to LBW (odds, 1.001; confidence interval 95%, 0.998-1.006).

Abstracts
the preferred mode; 2) homogeneous lung disease, in which pressureregulated volume control is preferred.The guideline was implemented in October 2008.We performed an uncontrolled, retrospective before-after design with a pre-test from January to July 2008 (T0) and two post-tests: May-November 2009 (T1); May-November 2010 (T2).All patients on conventional invasive mechanical ventilation during these periods were included.Outcome measure was the percentage of physicians' adherence to the ventilation protocol.We measured this by describing the ventilation mode on the first hour on the day of admission and the cause of respiratory failure, to distinguish in which group this patient belonged.

NON-INVASIVE VENTILATION (NIV) IN CHILDREN -ESTABLISHMENT OF A PEDIATRIC NIV SCORING SYSTEM
doi:10.1136/archdischild-2012-302724.0994K Bohn, S Gehring, R Huth, C Martin.Children's Hospital of the University Mainz, Mainz, Germany Objectives Non-invasive ventilation (NIV) is being increasingly used in children with respiratory failure in order to avoid intubation and associated problems.We analyzed the efficiency of NIV in children and the outcome of our patients.Methods In a retrospective study children who received NIV over the last 7 years were analyzed.Included were all children that had at least more than one hour of NIV and a cardiological disease or an infection of the airway.Patients were divided in subgroups according to their underlying disease.The following parameters were analysed: age, gender, weight, mode of NIV, hemodynamic and ventilatory status, blood gas analysis, days of hospitalisation and mortality rate.Results 70 patients between the age of 1 day to 28 years that received NIV were analyzed.The study population consisted of: 35 cardiological patients (50%) and 35 patient with an infection of the airway (50%).Children that had to be intubated because of a respiratory failure were classified as nonresponders.The overall rate of responders was at least 79%.Response correlated significantly with the Positive End-Expiratory Pressure (PEEP) values, pCO 2 and FiO 2 at 6 hours after initiation of NIV.Conclusion NIV offers an effective and successful alternative to conventional mechanical ventilation of children with respiratory failure.Due to advances in the currently available equipment and NIV algorithms we could significantly improve the rate of responders.Based on our findings we established a pediatric NIV score helping to predict NIV success.

IMPACT OF VENTILATOR-ASSOCIATED PNEUMONIA ON TREATMENT AND LENGTH OF STAY IN CRITICALLY PEDIATRIC PATIENTS WITH LOWER RESPIRATORY SYSTEM INFECTION
doi:10.1136/archdischild-2012-302724.0995 S Stabouli, A Violaki, E Volakli, L Vogiatzi, K Skoumis, M Sdougka.PICU, Hippokration Hospital, Thessaloniki, Greece Background and Aims Ventilator-associated pneumonia (VAP) may complicate the hospital course in critically ill children with 994 995 respiratory failure.Bronchiolitis was the most frequent condition (28%), followed by upper airway obstruction (15.2%), acute cardiogenic pulmonary edema (15.2%) and pneumonia (14.4%).CPAP was the respiratory mode more used.NIV success rate was 67.5%: 2.3% in the first hour, 32% between 1 st -12 th hour and 23.3% between 12 th -24 th hour.Failure rate was greater among patients with type I respiratory failure (34.9%) and acute respiratory distress syndrome (66.7%).A lower heart and respiratory rate at 6 hours were associated with NIV failure (p<0.05).Conclusions NIV is a useful and increasingly used ventilatory mode in PICU.Type I respiratory failure, decrease in heart rate and respiratory rate at 6 hours were risk factors for NIV failure.More studies involving predictive factors in children are still needed.

NEBULISED ILOPROST AND NONINVASIVE RESPIRATORY SUPPORT AS A FIRST TREATMENT FOR HYPOXAEMIC RESPIRATORY FAILURE IN EX-PRETERM INFANTS: PRELIMINARY EXPERIENCE
doi:10.1136/archdischild-2012-302724.0992Pediatrics,  Pediatric Cardiology, Catholic University of the Sacred Heart, A. Gemelli Hospital, Roma,  Italy; 3 Department of Cardio-Thoracic Anaesthesia, St. George's Hospital NHS, London,  UK   Objective To describe a series of ex-preterm infants admitted to pediatric intensive care unit because of acute hypoxaemic respiratory failure complicated by pulmonary hypertension who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO).Methods Open uncontrolled observational study, Pediatric Intensive Care Unit, University Hospital.

Measurements and Main Results
Ten formerly preterm infants with acute hypoxaemic respiratory failure and pulmonary hypertension, of whom 8 had moderate to severe bronchopulmonary dysplasia.Median age and body weight were 6.0 (2.75-9.50)months and 4.85 (3.32-7.07)kg, respectively.We observed a significant early oxygenation improvement in terms of PaO 2 /FiO 2 increase (p=0.001) and respiratory rate reduction (p=0.01).Hemodynamic also improved, as shown by heart rate (p=0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (p=0.0137).NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil.Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxic-hypercarbic patients were most likely to fail noninvasive approach.Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month postdischarge follow-up.Conclusions The noninvasive approach combining NIV and neb-ILO for ex-preterm babies with respiratory failure and pulmonary hypertension resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements.

IMPLEMENTATION OF VENTILATION POLICY IN
989 on September 21, 2023 by guest.Protected by copyright.http://adc.bmj.com/Arch Dis Child: first published as 10.1136/archdischild-2012-302724.0991 on 1 October 2012.Downloaded from A PICU doi:10.1136/archdischild-2012-302724.0993A Duyndam, B van Driel, RJ Houmes, D Tibboel, E Ista.Intensive Care Kinderen, Erasmus MC -Sophia Childrens Hospital, Rotterdam, The Netherlands Background and Aims Pediatric intensive care units (PICU) worldwide use different ventilators with a wide variety of ventilation modes.As an unambiguous international ventilation guideline, we developed one.After implementation we evaluated to what extent physicians adhered to the new guideline.Method We developed a ventilation guideline accounting for two groups: 1) heterogeneous lung disease, in which pressure control is 992 993 on September 21, 2023 by guest.Protected by copyright.http://adc.bmj.com/Arch Dis Child: first published as 10.1136/archdischild-2012-302724.0991 on 1 October 2012.Downloaded from